Steven Bott, MD is well versed in crisis management. His roles include cardiac and trauma anesthesiologist at the University of Utah, and medical director, flight physician, and mechanical circulatory support transport program director with AirMed, the university’s critical care air medical transport program that represents six helicopters, two airplanes, and 10 separate flight teams 24/7. He had also commanded a federal Disaster Medical Assistance Team (DMAT) for 10 years, an experience that proved critically important during the pandemic.
“As the pandemic pushed people out of their comfort zones, strong leaders emerged in the process,” said Dr. Bott.

DMATs, operated by the National Disaster Medical System (NDMS), are designed to provide high-quality rapid-response medical care when natural or man-made disasters overwhelm state, local, tribal, or territorial resources. After leading emergency response teams in the aftermath of hurricanes Katrina, Harvey, and others, Dr. Bott already knew how to work in a rapidly changing environment.

“The incident command structure, developed by emergency response organizations and the military, was a perfect fit for our department at the beginning of the pandemic. With the incident command system (ICS) in place and the problem identified, the departmental command staff could quickly collaborate with other departments, and that empowered and enabled others to know how to lead their respective areas,” he said. As new problems emerged, potential leaders were quickly identified by the command staff and were empowered to solve them.

A good communication structure was also in place, he said.

“Using ICS, our span of control and chain of command were well defined and greatly respected and became a fantastic tool to bring in new leaders while current leaders took on new responsibilities,” said Dr. Bott.

Even those at the top knew the importance of accepting when they didn’t have all the answers and were willing to work collaboratively, he said.

“It’s important for leaders to acknowledge their humility, knowing you may fail or that you don’t have all the answers, but as a team of leaders, we’ll figure it out together knowing we’re going to make it work together.”

Especially during a global pandemic.

Leadership creates new programs and publications

“The pandemic brought new challenges in the area of intubating patients with COVID-19,” said Dr. Bott. “At the same time, no one knows how to intubate patients better than anesthesiologists. We were in the best position to figure out how to do it safely, and to train hundreds of providers from multiple departments in our simulation training center… now!”

Throughout the university, clinicians and non-clinicians alike stepped up. This led to the development of The University of Utah COVID-19 Respiratory Management Guide, a collaboratively created living document tracking best practices for the management of COVID-19. The guide was updated as new data and resources became available and was supplemented with simulation training models and video tutorials as well as apps for quick reference (; Disaster Med Public Health Prep 2021;15:e19).

Managing the initial response to the SARS CoV-2 pandemic highlighted three areas that emerged as most important: education, collaboration, and provider safety with respect to PPE.

Collaboration was also already in place between critical care, anesthesiology, surgery, emergency medicine, and AirMed, Dr. Bott said. But the pandemic required better interdepartmental collaboration and new collaboration with other health care organizations and state and local governments.

“The true application of collaborative teamwork strengthened as we began to break down some of those silos,” said Dr. Bott. “But silos don’t work in a crisis. You have to be willing to reach out to others and use their resources to get things done quickly.”

Amy Gallagher is a certified English teacher and an internationally published journalist who has covered the health, medical, aviation, and military-rescue fields.